| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,509 |
1,408 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,512 |
1,425 |
$31K |
| D0274 |
Bitewings - four radiographic images |
911 |
846 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
560 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,601 |
1,452 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
229 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
84 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,285 |
1,174 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
215 |
$8K |
| D1120 |
Prophylaxis - child |
180 |
168 |
$5K |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$110.00 |